Drug Pronunciations

Selective β-1 blocker. FDA indicated for angina, arrythmias and hypertension. Not frequently prescribed.

Diuretic in the class of carbonic anhydrase inhibitors. FDA indicated for acute mountain sickness, ADRs that lead to edema, CHF complicated by edema, and epilepsy. It is also indicated as an adjunct for glaucoma, which is the most frequent usage of this class of drugs. May cross react with patients who have sulfa allergies. Tinnitus is common early in therapy.

Potassium sparing diuretic. Most frequently used in combination with Hydrochlorothiazide (Moduretic®).

Class III antiarrhythmic (drug of choice for arrhythmic therapy). Affects whole heart, increases refractory period, increase QT interval but unlike most antiarrhythmic drugs it is not proarrhythmic. Difficult drug to dose; half-life is approximately 53 days due to large volume of distribution and an active metabolite. Metabolism is primarily hepatic. Amiodarone is a substrate for CYP 2C9, 3A4 as well as an inhibitor for CYP 1A2, 2C9, 2D6, 3A4. Drug interactions are unavoidable and are both kinetic and pharmacodynamic in nature. Amiodarone has an extensive side effect profile including pneumonitis (which occurs in up to 10% of patients), increases in LFTs, ocular complications, and skin discoloration (patient can literally turn blue). There are guidelines for administration of a loading dose, however due to the long half-life and risk of side effects most patients are sent home on a maintenance dose of 100-400 mg/day and reassessed in 2 months (the lower end of the dosing spectrum is reserved for atrial fibrillation and the higher end of the spectrum typically for ventricular arrhythmias).

Dihydropyridine Calcium Channel Blocker. The drug is representative of the entire DHP class. Results in greater peripheral vasodilation than non-dihydropyridine CCBs (Dilatiazem/Verapamil). Amlodipine is one of the least likely DHPs to cause reflex tachycardia and therefore can be used in CHF as well as to control HTN and angina. Starting dosages are typically 2.5-5mg/day with a maximum dose of 10mg QD.

Reduces platelet count through an unknown mechanism. Indicated for myeloproliferative disorders. Common side effects include; edema, palpitations, GI distress, dizziness, dyspnea and fever. Drug interaction with Gingko.

Irreversibly inhibits breakdown of Arachadonic Acid to Thromboxane A2 (via the enzymes COX-1 and COX-2) thereby inhibiting platelet activation and the formation of prostaglandins. It is the drug of choice for inhibiting platelets in patients who have not had a MI or stent placed. The lower doses (81mg) are more COX-1 selective, whereas higher doses are required to provided pain relief through inhibition of COX-2. ASA is not recommended for routine use in children due to the risk of Reyes syndrome.

Cardioselective β-blocker. Hydrophilic. Representative of its class. Indicated as alternate 1st line agents in HTN. Also indicated for tachyarrhythmias, and in stable HF. The use of BB in HF counteracts the destructive cardio-remodeling process and reverses damage. Patients should be warned that their condition may seem to deteriorate when initiating therapy on BB, but tolerance will develop. Patients must be titrated to adequate dosages. Excessive slowing of the heart rate will cause fatigue. Contraindicated if HR is less than 60 bpm. (Note: Metoprolol XL is the preferred β-blocker for HF per clinical trials). Caucasians respond more favorably to BB for HTN due to their high renin levels.

HMG-CoA reductase inhibitor (“statin”). This is the 1st line class of therapy for dyslipidemia that requires lowering of LDLc. Atorvastatin is the second most potent statin, lowering LDL by approximently 50%. It is eliminated via CYP 3A4 resulting in the possibility for drug interactions. Little effects on lowering triglycerides or raising HDL and should not be prescribed if these are the primary therapeutic goals. Most important side effect is rhabdomyolosis, which usually presents as chest/upper body muscle aches. Drug should be Discontinued if this occurs. Monitoring of LFTs is indicated.

ACE-inhibitor. See Lisinopril

Thiazide diuretic. See Hydrochlorothiazide.

Thiazide diuretic. See Hydrochlorothiazide.

Cardioselective β-adrenergic antagonist. Less frequently prescribed. See Atenolol.

Fibrate. See Gemfibrozil

Cardioselective β-adrenergic antagonist. Less frequently used due to its lipophilic nature, thus a greater propensity of CNS effects. See Metoprolol.

Class III antiarrythmic. No longer available in the US. Formally used to terminate ventricular arrythmias. It had the added benefit of controlling atrial fibrillation, however it was very hypotensive and proarrythmic (hence its removal).

Loop diuretic. Most potent class of diuretics. Like Furosemide, but preferred in situations of decompensated heart failure due to its predictable absorption.

Angiotensin receptor antagonist (ARB). See Losartan. Drug of choice in HF, as per clinical trials.

Angiotensin Converting Enzyme Inhibitor (ACE-I) see Lisinopril (representative agent). Captopril is like Lisinopril, however, it is an older generation ACE-I and requires BID dosing as well as a test dose at the initiation of therapy to test for extensive hypotension. Captopril, unlike the rest of the agents in its class, contains a sulfhydral group which causes a cross reactivity with all sulfa related adverse effects (eg: rash, metallic taste).

Mixed α/β blocker (inhibits α1, β1, β2). Like Labetolol but the drug of choice if a CHF patient is experiencing hypertensive urgency.

Thiazide diuretic. Not commonly prescribed. See Hydrochlorothiazide

Bile acid sequesterant (BAS), representative of its class. This is an older generation of cholesterol lowering drugs, which bind up bile salts in the GI tract and cause their excretion, thus blocking the absorption of cholesterol. They are not frequently prescribed and were much more popular before the statins were available. The class as a whole moderately lowers LDL and may have some positive effects on HDL. The main problem with BAS is their propensity to cause GI distress. This is an unavoidable side effect mediated through the drugs mechanism of action.

Bile acid sequesterant. See Cholestipol. Cholestyramine is available in a powder that is often mixed with orange juice.

Fibrate. See Gemfibrozil.

Clavulanic acid is a ß-Lactamase Inhibitor used in combinations with Amoxicillin (Augmentin®) and Ticarcillin (Timentin®). Used in a wide variety of infections ranging from skin, UTI, respiratory tract infections to ear infections.

Fibrate. See Gemfibrozil.

Stimulates α2 receptors and decreases concentrations of NE. It is indicated for hypertensive urgency but it must be used with a diuretic. If discontinued abruptly a “discontinuation syndrome” can develop due to sympathetic hyperactivity. Signs and symptoms include anxiety, tachycardia, H/A, tremor, muscle pain and N/V. The best way to manage this is to reinstitute clonidine or give a mixed α/β blocker such as labetolol. Clonidine is available in patches and is usually prescribed this way.

P2Y12 receptor blocker in the class of thienopyridines. Inactivates platelets. Indicated in patients post MI/stent placement. Clopidogrel irreversibly inactivates the platelet, thus the half life of the drug is moot, the effect lasts for the life of the platelet (7-10 days). Clopidogrel is a prodrug and requires activation via hepatic transaminases (specifically CYP3A4). The drug should not be used in patients with CAD and no history of MI/stent placement due to an increased risk of bleeding. The drug of choice in these patients is Aspirin.

Cloxacillin is a ß-lactamase resistant and acid stable Penicillin.

Cycloserine has a broad spectrum but is mostly used as a second line Anti TB agent. Its toxicities include CNS disturbances, anxiety, confusion and drowsiness. It acts as a competitive inhibitor of Alanine racemase and transferase.

Carbonic anhydrase inhibitor. Can be used to lower blood pressure, but more commonly used in glaucoma. Not the preferred therapy

Dicloxacillin is a ß-lactamase resistant and acid stable Penicillin.

Historical. Related to Digoxin, no longer used clinically.

An “old world” drug, derived from the foxglove plant. Indicated in heart failure (HF) as an additive to the regimen of patients with mild-moderate disease (eg; ejection fraction less than 40%) who are still symptomatic on ACE-I and β-blockers as well as to control atrial fibrillation. The drug is associated with some interesting side effects and a very narrow therapeutic index to the point that “Digoxin toxicity” is its own unique clinical diagnosis. The most common side effect of dig toxicity is GI distress (nausea, vomiting, diarrhea), but the most unique are the visual disturbances, which include halo formations and a greenish-yellow visual hue.

Non dihydropyridine CCB (as well as class IV antiarrythmic). Indicated for HTN, angina and AV node arrythmias (such as SVT). The drugs in this class are negative inotropes and can worsen CHF. However, Diltiazem is preferred over Verapamil and can be cautiously used in HF due to the fact it causes less AV node blockage and less decreased contractility than verapamil. Although non-DHPs are more dangerous to use in HF, they are more effective because they act centrally, rather than just causing peripheral vasodilation like the DHP (such as amlopidine). Constipation is a common side effect, but is less severe than with Verapamil.

Sympathomimetic ionotrope, stimulating both α and β receptors. Ionotropes are used in decompensated HF as well as other emergency situations in which the heart begins to pump less blood (shock, etc) to increase cardiac index (CI), increase cardiac output (CO), increase contractility and decrease systemic vascular resistance (SVR). Dobutamine is cleared hepatically with a half life of less than 10 min, making it the perfect medication for emergency situations that require a drug to perform its action, and then quickly be out of circulation. Unfortunately, the drug is also proarrythmic and increases the HR, both of which are undesirable effects.

An α-1 adrenergic antagonist representative of its class. Doxazosin results in arterial and venous vasodilation without reflex tachycardia. The class has fallen out of favor due to findings of the ALLHAT trial that demonstrated a 25% increase in cardiovascular events if used to treat HTN. The class has a niche however in the treatment of patients who are hypertensive and have BPH. The prostate is predominantly covered in a-receptors and blockage of these receptors allow shrinkage of prostate mass, thus relieving the symptomology of BPH while also having the added benefit of lowering the patient’s blood pressure.

An ACE Inhibitor. See Lisinopril.

Class II antiarrythmic (β-adrenergic antagonist). Indicated for SVT, V-tach and in emergency situations involving ischemia and hypoprofusion (eg; shock, HF). It is usually used in acute care due to its short half life (9min). The most concerning side effect is hypotension.

Loop diuretic. See Furosemide.

Carbonic anhydrase inhibitor. A diuretic, most frequently used in glaucoma. See Acetazolamide.

A Dihydropyridine Calcium Channel Blocker. See Amlodipine.

A new generation fibrate. Unlike the statins the fibrates do not substantially lower LDLc, but are used to lower triglycerides (TG) and raise HDLc. Tricor is an improvement over the first generation fibrate, Gemfibrozil, due to its decreased likelihood to cause rhabdomyolosis when used in combination with the statins.

A class IC antiarrythmic. Indicated in life threatening ventricular tachycardia (though it works well for controlling premature ventricular contractions (PVCs) in people without arrythmias). It is extremely proarrythmic due to its negative inotropic effects (which depress myocardial function). CNS effects are a common side effect.

HMG CoA reductase inhibitor (“statin”). Fluvastatin is the least potent of the statins, lowering LDLc by less than 30%. Like most of the other statins, it is metabolized via CYP 450 system in the liver. However, Fluvastatin is an inhibitor of 2C9 and not a substrate of 3A4. The major side effect of concern is rhabdomyolosis, but is more common when combined with fibrate drugs (see Atorvastatin).

ACE Inhibitors. See Lisinopril.

A Loop diuretic. The most potent class of agents indicated for diuresis, however, loops are not the most potent antihypertensive diuretic (see HCTZ). Used mainly for diuresis of fluid overloaded patients suffering from renal disease, CHF and other edematous disease states. Resistance can develop to the diuretic effect. Some efficacy can be recovered if a loop/thiazide combination is employed. However, once the dosages are maxed renal patients will usually require dialysis. Furosemide is not the loop of choice during exacerbations of CHF, due to a more erratic absorption in this state.

A drug in the class of fibrates. It lowers triglycerides and increases HDLc significantly with only minor LDLc lowering. Its mechanism of action is unclear. A major drug interaction can result when Gemfibrozil is used in combination with statins. Gemfibrozil increases the active form of the statin in the body, leading to a higher incidence of rhabdomyolosis.

An Adrenergic antagonist. Not available in the US.

Direct vasodilator (of arteriolar smooth muscle). Indicated in hypertensive urgency in combination with a diuretic as well as a β-blocker. Also indicated in CHF (half of the combination drug Bidel with Isosorbide). Side effects are mainly associated with the direct vasodilitory qualities of the drug. However, in slow acetylators there is a possibility of development of a lupus-like syndrome.

A thiazide diuretic and the representative of its class. HCTZ is the drug of choice for initial hypertensive therapy per the ALLHAT study. Its mechanism of action in HTN is through vasodilatation and not diuresis. It is not usually used to diurese, however, if a patient with impaired renal function, CHF or some other form of resilient edema becomes resistant to loop diuretics, thiazides can be used to prolong the efficacy of loops by blocking reabsorption of Sodium in the distal convulated tubule. HCTZ is also extremely inexpensive and an entire year’s supply can usually be dispensed for a cash price below the pharmacy’s “minimum charge”, which is useful if a patient is on a fixed income.

A class III antiarrythmic drug, indicated for chemical cardioversion (aka: acute termination of atrial fibrillation/flutter and adjustment to normal sinus rhythm). This drug is contraindicated if a patient has a bad heart due to its extreme proarrythmic potential. It is usually prescribed as a single dose therapy. Ibutilide has a very short half life (6hrs), therefore, after the single dose is given it can be determined if it “worked” to convert, or if a different mode of action is required. Due to its proarrthymic potential a patient’s cardiogram must be closely followed to avoid torsades or branch bundle block. This drug is not frequently used due to the increased ease and safety of implanting electrocardioverters.

Imipenem is a very efficient agent with the broadest spectrum of any antibiotic available in the United States, and is reserved for serious infections. It is hydrolyzed by renal dehydropeptidase (DHP-I) and is thus combined with a DHP-I inhibitor, Cilistatin.

A thiazide diuretic. See HCTZ

An Angiotensin receptor antagonist (ARB). See Losartan.

A second line therapy for acute symptomatic bradycardias if a patient fails atropine. It can also be used to rectify torsades. It is usually given as a “wide open” infusion in emergent bradycardic situations, and then once a response is seen, the dose will be tapered.

A direct vasodilator (of arteriolar smooth muscle). Used in CHF as the combination drug Bidel with Hydralazine. Bidel has been shown to be a more effective initial therapy than ACE-I in African Americans to both lower BP and increase survival in HF patients. However, the combination can be dispensed separately for a more economical therapy if a patient is concerned over drug prices.

Belongs to the Dihydropyridine Calcium Channel Blocker. See Amlodipine.

A mixed α/β blocker (inhibits α1, β1, β2) which works like a combination of Propranolol and Doxazosin. It is indicated for hypertensive urgency, but must be used in combination with a diuretic. Associated with a unique lupus-like side effect. Can be used as an alternative to re-initiation of clonidine if a patient is experiencing the Clonidine “discontinuation syndrome”.

A class IB antiarrythmic. Indicated as second line therapy for Ventricular Tachycardia (V-tach). It is available via IV infusion only. It is pharmacokinetically dosed with a therapeutic range between 2-6 mcg/ml. Lidocaine is hepatically cleared to two active metabolites MegX and GX, which are both antiarrythmic as well as neurotoxic. Due to these metabolites, CNS side effects are common. These side effects are first manifested as dizziness and slurred speech and can progress to seizures if toxic levels continue.

An Angiotensin converting enzyme inhibitor (ACE-I). Primary indication is in HTN. Blocks ACE leading to decrease in angiotensin II, decrease in aldosterone, inhibition of bradykinin breakdown and increases in vasodilatory prostaglandins. Lisinopril is representative of its class and the most commonly prescribed ACE-I. It is one of the newer generation agents and does not require a test dose like Captopril. ACE-I are the agents of choice for patients with HTN and concomitant diabetes due to the positive effects of these drugs on the kidney. The primary side effect of concern is a dry cough. Tolerance does not develop to the cough and if it greatly bothers the patient switching to an ARB many be indicated. ACE-I are one of the only antihypertensive drugs that will actually improve quality of life, resulting in the patient “feeling better”. Care must be taken if these drugs are used in combination with potassium sparing diuretics or ARBs due to increased propensity of hyperkalemia.

An Angiotensin receptor antagonist (ARB) and a representative of its class. Primarily indicated for HTN. Blocks activation of angiotensin II by binding to angiotensin I receptors. Works similarly to ACE-Is, however, ARBs do not block bradykinin breakdown thus there is less propensity to cause the dry cough side effect. Research has shown there to be benefit when ARBs are used in combination with ACE-I or as initial therapy. However, the class is usually reserved for patients that fail ACE-I due to the fact that ACE-I are more cost-effective. When used in combination with potassium sparing diuretics or ACE-I hyperkalemia can occur. Interestingly, while the dry cough should not occur mechanistically, patients still report cough while on ARBs.

An HMG CoA reductase inhibitor (“statin”) of moderate potency, believed to lower LDLc by approximately 35%. It is metabolized via hepatic transaminase CYP 3A4. It is currently the only statin that is available as a generic equivalent and is a good substitution for patients without insurance, or with high copays for brand name products.

An osmotic diuretic (structurally similar to caffeine). Though it is a diuretic, it is not used for hypertension or chronic edema. Mannitol tends to be prescribed in acute situations such as ARF and ARF prophy, drug toxicity due to a renally cleared substance, cerebral edema with raised intracranial pressure and raised intraocular pressure. It is available via IV solution only.

Meropenem is a broad spectrum antibiotic and resistant to ß-Lactamases. It is indicated in infections caused by multiresistant bacteria.

A Carbonic anhydrase inhibitor, used as a diuretic, most frequently used in glaucoma. See Acetazolamide.

A Penicillin that is resistant to attacks by ß-lactamases.

An α-adrenergic agonist. Drug of choice if hypertension must be controlled during pregnancy (Pregnancy category B). Common side effects include; sedation, lethargy, depression and postural hypotension but there is a possibility of hemolytic anemia or hepatitis. Control of hypertension during pregnancy is vital to preventing fetal complications as well as preeclampsia.

A Thiazide diuretic. See Hydrochlorothiazide.

A cardioselective β-blocker. The class is contraindicated in decompensated HF, but prevents destructive remodeling if given in stable HF and is the drug of choice for HTN complicated by HF. Unlike Atenolol, Metoprolol is lipophilic. This allows it to cross the blood brain barrier, leading to an increase in CNS related side effects. “Metoprolol” usually refers to Metoprolol tartate which must be given twice daily and is usually prescribed for HTN. Metoprolol succinate (Toprol XL) is given once daily and was shown through clinical trials to be the drug of choice for preventing cardio-remodeling.

A class IB antiarrythmic. Indicated for Ventricular Tachycardia (V-tach) and is available only orally. It has no hematologic effects, but commonly causes GI distress. Mexelitine is mainly used as a “last ditch” effort once all other possible therapies have failed.

A phospodiesterase inhibitor ionotrope. Unlike Dobutamine, Milrinone provides non-receptor mediated ionotropy. It is indicated in the same instances as Dobutamine, but is cleared both renally and through hepatic mechanisms in approximately 2 hours. It has been shown to be less proarrythmic than Dobutamine, but much more costly. Milrinone is the drug of choice if a patient has previously been on β-blocker therapy, due to the fact that Dobutamine is a β-agonist and may not be 100% effective in these patients.

A direct vasodilator of arteriolar smooth muscle. Indicated in hypertensive urgency, like Hydralazine, and is commonly prescribed to renal failure patients on dialysis. It has a side effect of hypertrichosis (excessive growth of body hair) and in the 1980s began to be marketed as the topical preparation Rogaine®.

A non selective β-adrenergic antagonist. Less commonly used for this reason. Hydrophilic so less prone to cause CNS affects.

A Penicillin that shows resistance to attacks by ß-lactamases.

A Dihydropyridene Calcium Channel Blocker. See Amlodipine.

Belongs to the Dihydropyridine Calcium Channel Blockers class. See Amlodipine.

Belongs to the Dihydropyridine Calcium Channel Blockers class. See Amlodipine. Originally indicated for HTN, but is now being employed to prevent vasospasm associated with subarachnoid hemorrhage, and cancer chemotherapy resistance.

Belongs to the Dihydropyridine Calcium Channel Blockers class. See Amlodipine.

A penicillin that shows ß-lactamase resistance and is acid stable, thus used in oral preparations.

A non selective β-adrenergic antagonist. See Propranolol.

The first penicillin used. It is effective only against Gram positive bacteria, is acid labile and can be destroyed by ß-lactamases. It is used as its sodium or potassium salt in parentral preparations, or as long acting IM injections as the procaine salt or benzathine salt.

An acid stable Penicillin, used in oral preparations.

Non selective lipophilic β-adrenergic antagonist. See Propranolol.

A thiazide diuretic. See Hydrochlorothiazide

An HMG CoA reductase inhibitor (“statin”) of moderate potency, lowering LDLc by approximately 35%. It is the only statin proven via clinical trials to decrease mortality via “primary prevention” (preventing the I of a patient’s first MI), as well as “secondary prevention” (preventing MI reoccurrence). It is metabolized renally, and therefore is not subject to as many drug interactions as Atorvastatin.

An α-adrenergic antagonist. See Doxazosin.

A class IA antiarrythmic. Indicated in SVT and ventricular tachycardia (V-tach). Procainamide is pharmacokinetically dosed with a therapeutic range between 4-12mcg/ml. 50% of the drug is cleared renally and 50% is cleared hepatically to the active metabolite NAPA, which is actually its own antiarrythmic drug that can be grouped in class III. Procainamide undergoes polymorphic metabolism. Possible side effects include a lupus-like reaction, which is more common in slow acetylators, as well as hypotension and torsades (due to the widening of the QRS interval).

A class IC antiarrythmic. Indicated for ventricular arrythmias and used in SVT. Propafenone has dose dependent bioavailability. Food also will increase the drug’s absorption. Propafenone is hepatically cleared with an active metabolite and exhibits polymorphic metabolism. Slow metabolizers experience more CNS side effects as well as some β blockade from the drug. Propafenone interacts with Digoxen, Warfarin and Metoprolol, increasing their available concentrations. The maximum dose of Propafenone is 900mg QD.

A non selective β-adrenergic antagonist. Highly lipophilic causing extensive CNS effects. Usually prescribed to alleviate effects produced by adrenergic stimulation such as trembling hands or pounding heart (“flight or fight” manifestations).

An ACE inhibitor. See Lisinopril.

A thiazide diuretic. See Hydrochlorothiazide.

A class IA antiarrythmic. Indicated in supraventricular tachycardia (SVT) and ventricular tachycardia (V-tach). It is pharmacokinetically dosed with a therapeutic range from 2-5mcg/ml. It is available in a sulfate salt (83% quinidine), gluconate salt (62% quinidine) and a polygalactate salt (60% quinidine). The most common side effect is diarrhea, but torsades is a real possibility due to the widening of QRS interval. Quinidine interacts with both digoxen and warfarin increasing their systemic concentrations.

An ACE Inhibitor. See Lisinopril.

Can be used as an antihypertensive in children, but in adults is a psychotropic agent used in refractory conditions. Not frequently used.

A HMG CoA reductase inhibitor (“statin”). The most potent LDLc lowering drug of its class. It is metabolized mainly via the kidneys, but there is also some CYP 3A4 hepatic metabolism as well. Recent evidence from clinical trials has demonstrated that Rosuvastatin may have the ability to dissolve plaque build up inside vessels resulting in “healing”. This may or may not be unique to this drug.

An HMG CoA reductase inhibitor (“statin”). Like Atorvastatin, it is used to lower LDLc. It is the 3rd most potent statin, lowering LDL by approximently 50%. Like Atorvastatin, it also is metabolized via CYP 3A4 and is subject to the applicable drug interactions.

A vasodilator, indicated in the same types of situations as Dobutamine, Nitroprusside decreases SVR, pulmonary capillary wedge pressure (PCWP) and mean arterial pressure (MAP). It also increases CI and CO but only increases HR slightly and is not associated with increases in oxygen demand or proarrythmic potential. Unlike Dobutamine and Milronone, the use of Nitroprusside requires placement of an arterial catheter, which is invasive and time consuming in an emergency. The drug has a structural element related to cyanide and thus cyanide toxicity can develop in which case the drug should be discontinued and the patient should be given Thiosulfate, Sodium Nitrate and Hydroxycobalamin.

An osmotic diuretic. See Mannitol.

A class III antiarrythmic drug. Indicated for life threatening ventricular arrythmias. Although Sotalol is a class III antiarrthmic, it actually is a racemic mixture that has significant class II (β blocking) capabilities. It is not frequently used and when used the HR and QT interval must be diligently monitored.

A Potassium sparing diuretic. Usually used in combination with thiazide diuretics when patients become hypokalemic, but are still deriving benefit from the thiazide. A related compound is found in Yasmin (contraceptive) and is alleged to help alleviate bloating associated with menstruation via mild diuresis. A unique adverse effect includes gynecomastia, however this is uncommon. Care must be taken to not allow the patient to become hyperkalemic.

A ß-Lactamase Inhibitor used in combination with Ampicillin in parenteral preparations in a variety of infections.

A potent ß-Lactamase inhibitor used with Piperacillin in parenteral preparations for various infections including skin, abdominal and pelvic infections, as well as pneumonia of moderate severity.

A cell wall biosynthesis inhibitor used in MRS and other infections from Gram positive bacteria. It binds to D-Alanyl-D-Alanine portion of the peptidoglycan and prevents it from being transported to the cell wall for cross-linking.

An Angiotensin receptor antagonist (ARB). See Losartan.

An α1 adrenergic antagonist. See Doxazosin.

This agent was originally isolated from streptomyces and turned out to be effective against 98% of the 31,000 species it was tested against and to inhibit most ß-lactamases. However, it is unstable in both acidic and basic conditions, and thus did not find clinical application.

A P2Y12 receptor antagonist in the class of Thienopyridines (see Clopidigrel). The drug is less frequently used due to its greater propensity to cause adverse events (blood dyscrasias, especially neutropenia, and GI issues).

A non selective lipophilic β-adrenergic antagonist. See Propranolol

A GPIIb/IIIa receptor antagonist. The GPIIb/IIIa blockers are the only class of drugs that inhibit platelet aggregation. Used only in patients experiencing non ST elevation MI (NSTEMI), and when placing a stent. Tirofiban reversibly blocks platelet aggregation, but Abciximab, another member of the class, blocks this irreversibly.

A class IB antiarrythmic. Indicated for ventricular tahycardia (V-tach), but not frequently used. It is available PO, but is not very effective. Tocainamide’s side effect profile is similar to Lidocaine, however there is also a risk of blood dyscrasias, which requires a weekly CBC to be drawn for the first three months of therapy.

An ACE-Inhibitor. See Lisinopril

A Potassium sparing diuretic, indicated in HTN. Frequently used in combination with thiazide diuretics if a patient becomes hypokalemic but is still deriving benefit from the thiazide. Dyazide and Maxzide are commonly used (both are a combination of Triamterene and HCTZ). Care must be taken to not allow the patient to become hyperkalemic.

A thiazide diuretic. See Hydrochlorothiazide.

An Angiotensin receptor antagonist (ARB). See Losartan.

A cell wall biosynthesis inhibitor used in MRS and other infections from Gram positive bacteria. It binds to D-Alanyl-D-Alanine portion of the peptidoglycan and prevents it from being transported to the cell wall for cross-linking. Resistance may arise by replacing the terminal D-Ala to Lactate, preventing one of the hydrogen bonds from forming.

A non Dihydropyridine Calcium Channel Blocker (as well as class IV antiarrythmic). Indicated for HTN, angina and AV node arrythmias (such as SVT). Causes greater vasodilation than Diltiazem but is not the preferred NDHP due to its greater negative inotropic actions as well as its propensity to cause severe constipation.

A Vitamin K antagonist in the class of coumarins. Warfarin is the only anticoagulant available PO. It irreversibly inhibits vitamin K dependent clotting factors (II, VII, IX, X), as well as protein C and S (the body’s endogenous vitamin K dependent anticoagulants). The drug is cleared hepatically via CYP2C9 and its half life is the length of the vitamin K dependent factors (the longest being factor II with a half life of 60 hours). Due to the inactivation of protein C and S, warfarin therapy must be initiated concomitantly with heparin, to combat the initial hypercoaguable state. Warfarin therapy is monitored via the patients INR. The drug is notorious for drug interactions due to its narrow therapeutic window. Other drugs that are CYP2C9 inducers or inhibitors interact with warfarin, as well as foods that contain vitamin K (such as green, leafy vegetables). Patients should be instructed to watch for bleeding/bruising while on warfarin, especially on the torso.